High Altitude Pulmonary Edema And Some Other Diseases Due To High Altitude

This is a more serious complication compared to AMS. Young subjects in apparently good health are more affected. It may manifest in newcomers and also in subjects acclimatized to high altitudes, if they ascend the height rapidly after periods of stay at lower altitudes. Altitudes above 2500 m can be harmful, but most of the cases occur at heights of 3050 to 4550 m. Heavy meal, physical exertion and too-rapid an ascent precipitate the condition. Symptoms start within 6 to 48 hours of reaching the station.

Though, pulmonary hypertension is invariably found as a consequence of hypoxia, only a small proportion of subjects develop acute pulmonary edema which tends to be patchy. The reason for the edema is not clear. Autopsy studies have revealed dilatation of pulmonary arteries and arterioles, congestion of capillaries, intravascular thrombi, perivascular hemorrhages, and alveolar edema. Cases of long duration may show hyaline membrane in the alveoli.

Clinical features: Many cases follow acute mountain sickness, but in some, pulmonary edema develops abruptly. Early symptoms are cough, tachypnea, dyspnea and chest pain. These are soon followed by hemoptysis, cyanosis, frothy expectoration, and intense chest discomfort. Oliguria may develop.

The course is variable. In some, the pulmonary edema worsens while in others, it may become subacute and persist for a few days. In severe cases, right sided heart failure may follow and this may precede death. Radiographic abnormalities include prominence of the pulmonary arteries, patchy edema which is more prominent in the upper and mid-zones and more marked on the right side. Electrocardiogram reveals acute right ventricular strain due to pulmonary hypertension.

Diagnosis: High altitude pulmonary edema should be anticipated in healthy subjects who develop vague cerebral and respiratory symptoms on reaching high altitudes. Early recognition and treatment are necessary to avoid rapid deterioration and death. Acute mountain sickness, respiratory infections, Cardiac failure, and malingering have to be differentiated from this condition.

Treatment: The patient should be hospitalized and administered oxygen. If oxygen is not available, the patient should be evacuated to a lower camp. Morphine, 15 mg and furosemide 40 mg should be given intravenously. In the majority of cases, there are enough to tide over an attack. Persistence of pulmonary edema is an indication for repeating furosemide. Physiological venesection by applying tourniquets proximately to the limbs, helps in reducing pulmonary edema. Precipitating factors such as respiratory infection have to be looked for and treated appropriately.

Prevention: proper training and conditioning for 1-2 weeks should be undertaken before reaching high altitudes. On reaching high altitudes all unacclimatized persons should avoid physical exertion for 48-72 hours. Furosemide 40 mg given orally daily for 2-3 days prevents the onset of acute pulmonary edema.

High altitude cerebral edema

This disorder is less common than pulmonary edema. Cerebral edema may follow acute mountain sickness several hours after reaching the high altitude. Pathological lesions consist of dilatation of cerebral vessels, cerebral edema and patchy hemorrhages. Early clinical features consist of lethargy, insomnia, dreamy state and irritability. Severe cases develop intense headache, confusion and coma before reaching the fatal end. Cheyne-stokes respiration may develop.

Treatment: The patient should be administered pure oxygen and evacuated to a lower camp. Dexamethasone given intravenously or intramuscularly in a dose of 4-8 mg gives relief.

Chronic mountain sickness-Monge’s disease, chronic soroche, high altitude disease

Some persons living at high altitudes lose their acclimatization and develop symptoms. Most of such reports have come from South America. Males are affected more than females. The mechanism is not fully understood. Features are those of alveolar hypoventilation. Palliative measures are only of temporary benefit. Therefore it is advisable to remove affected individuals to low altitudes. The whole picture reverts tp normal on reaching low altitudes.

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Exactly What Causes Tinnitus?

The ear nerves generate electric signals which are received by the brain. These signals are originated by pressure of external waves of sound that come in contact with the small and highly sensitive hairs that are located in the inner ear area. These signals are then interpreted as sounds by your brain. However, this processing of sound by the brain can get interrupted when the inner ear hairs become damaged or destroyed. When this occurs, the brain receives sounds that are abnormal, such as ringing, buzzing, or whistling. These abnormal noises are transferred to your ear, which makes you have to listen to these annoying noises persistently.

These abnormal noises are called tinnitus.

There are specific tinnitus triggers that are often times mistaken as the real cause. This condition needs to be analyzed with an open mind, as it can be caused by several different things. For instance, consider sinus disorders. These types of problems are not the main underlying tinnitus factors. They are only triggers for this condition. One of the main causes of tinnitus is high blood pressure, which normally occurs because of the wrong lifestyle.

You must treat this problem with a holistic approach. Let’s take a close look at which factors really cause tinnitus.

High Stress or Acute Depression:

Your ears may appear healthy, and medical check-ups don’t show any problems, but tinnitus can still occur in people with these conditions.

These problems can be decreased or even prevented with a holistic lifestyle approach.

High Stress or Severe Depression: Your ears may appear healthy, and medical check-ups don’t show any problems, but tinnitus can still occur in people with these conditions.

Acoustic Neuroma:

This is a tumor that causes tinnitus. These tumors form on the brain’s nerves, and extend into parts of the ear. These nerves normally aid in a person’s hearing, and help them retain their balance, but don’t work right when this tumor is present. Vestibular Schwannoma is another name that’s given to these problems, which usually just affects one of the person’s ears.

Meniere’s disease:

This is a medical condition that afflicts the inner ear regions. It is caused by the fluid pressures in the ear which results in tinnitus.

Head/Neck Damage:

This affects the system of nerves adversely, and can hamper the proper functioning of these nerves. The brain normally suffers also, and tinnitus occurs.

Old Age:

As a person grows older or becomes senile, they may lose their listening powers. This usually occurs after they reach 60 years of age, and is known as Presbycusis.

Constant Loud Sounds:

If a person works in a loud factory or workplace, they will constantly have to hear loud high pitched sounds, which can cause tinnitus. Loud music and loud guns can also contribute to this condition.

Ear Wax Build Up:

When ear wax reaches past the certain normal level, tinnitus will occur in many people.

Atherosclerosis: When the blood vessels that are located in the ear are affected, they become very narrow and tinnitus will occur. This keeps these nerves from functioning correctly to your heart also. The main sound impulses that are received by both ears are then affected.

High Blood Pressure:

High blood pressure can cause tinnitus, in much the same way as artherosclerosis. It cannot supply blood to the head and neck which is the main cause of the problem.

Head/Neck Tumors:

These tumors cause the pressure to increase on the vascular neoplasm, such as blood vessels in the head or neck. Tinnitus will then commonly occur.

Incorrect Arteriovenous Connection Formations:

Many people suffer from tinnitus that occurs from an incorrect formation of the connections binds the veins and arteries. When, arteriovenous malformation (AVM) happens, tinnitus usually only affects one of the person’s ears.

Can medications cause or be responsible for tinnitus? In truth, there are medicines that can cause tinnitus symptoms. Some medications not only cause tinnitus, but can even make these symptoms worse. Below are the following medications that can be responsible for causing or intensifying tinnitus symptoms.

Medicines That Cause Tinnitus:

Antibiotics such as chloramphenicol, erythromycin, tetracycline, vancomycin, and bleomycin.
Cancer Drugs such as mechlorethamine, and Vincristine
Diuretic drugs, especially bumetanide, ethacrynic acid, or furosemide.
Quinine drugs, which treat malaria and other similar diseases.
Aspirin can cause tinnitus; the risk is especially high when it is taken at high dosages or for a long time.

The causes of tinnitus need to be detected correctly and then treated accordingly. There are many different things that can cause tinnitus, so it is a multi faceted problem. Most conventional treatments don’t really find out the root cause, and treat only the symptoms of the condition. This makes the relief they offer only temporary. Using the holistic approach will treat your tinnitus by treating your whole body as one structure. You will have to change your lifestyle, diet, and use certain medications and herbal remedies. Using the holistic approach, you will be able to find out the cause of your tinnitus, and then be able to fix the problem. This makes it no surprise that the holistic approach works best for curing your tinnitus.

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Summer, Travel and Medication Part 4 – Mountain Sickness and Heat Stroke

Mountain Sickness

One can prevent acute mountain sickness (symptoms are headache, lack of appetite, nausea, dizziness and feeling very tired, these symptoms are found shortly after climbing above 2500 m) by reducing the speed at which one is climbing to these higher altitudes, thus giving the body more time to adjust. Medical prophylaxis is rarely advisable, unless in people who had mountain sickness before or when a rapid ascent is needed (during a rescue operation for instance). Acetozolamide is the product of choice, but dexamethason is a good alternative when the first medication is not tolerated or has contra-indications. Please refer to a specialized physician for more advice on this matter. The preventive use of aspirin, ginkgo biloba, spironolaction and furosemide has not been scientifically proven.
When confronted with the acute symptoms of mountain sickness it is best to stop the climb, take rest and preferably start to descent again. Normally the symptoms will disappear after a few days of acclimatization. In the mean time painkillers like Tylenol and medication against motion sickness can offer some relief. It is very important though to recognize the symptoms of mountain sickness in an early stage since this condition can rapidly cause fatal brain and/or lung edema.

Heat Stroke

In order to try to avoid a heat stroke, a person showing symptoms caused by an access of heat, should be rehydrated (orally and intravenously) and cooled down. Heat stroke itself needs an emergency treatment (rapid cooling and carefully rehydrating). Some medication can aggravate the risk and the degree of severity of a heat stroke. Talk to your doctor to find out if you are taking this kind of medication. In the event of a foreseeable heat wave, it could be considered to evaluate the use of these medications or even temporarily stop the treatment. This kind of evaluation should only be done by the medical staff however; this is not something you can decide on your own. Talk to your doctor.
Alcohol and drugs like cocaine and ecstasy can worsen the effects of a heat stroke.

This was part 4 of a series of 6 articles about travel and medication. The other parts being: Part 1 Vaccinations – Part 2 Travelers diarrhea – Part 3 Lyme’s disease – Part 4 mountain sickness and heat stroke – Part 5 Malaria – Part 6 motion sickness and jetlag.

Eddy De Vos is the owner of the Spain-Holidays -Advisor.com website, a website about travel and Spain. It contains useful tips for your next trip, be it to Spain or anywhere else in the world. Of course if you are planning a trip to Spain there is no better place to start than Spain Holidays

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Can My Herbal Supplements Harm Me?

Unknown to most people is the fact that everyday foods and Herbal supplements can and do interact with popular prescription medications. I became interested while talking to my Pharmacist that my son couldn’t take decongestant cold medications with his heart medication. Well, I knew about interactions between two drugs, but when the Pharmacist told me he couldn’t have grapefruit juice, I was stunned. Seems that grapefruit juice increases the blood concentrations of the drug. Basically that means that it greatly enhances the effects of the drug which could result in an overdose of the medication. This is everyday grapefruit juice! It got me wondering about other everyday foods and Herbs we take. Below are a few foods and Herbs that have an effect on your medications.

This list is a basic guide, and is by no means the meant to replace your Doctor or Pharmacist. Consult with them about any prescriptions you are taking and the foods and Herbs that will interact with them. Although I have taken this information from a handout from a local Hospital, Use this information at your own risk. Again, I am not a Doctor or Pharmacist, and I have had NO medical training, so please consult with yours for more information.

People usually ask if Herbal supplements change the way their prescription drugs work. The answer is YES! Some medications should never be taken with Herbal supplements. Some can cause unwanted side effects or cause the medication to stop working to their full effect.

Another misconception about supplements is that they are completely safe because they are natural. Yes, they may be from plants, but they are not natural to your body. Herbal supplements are not tested or inspected like prescription drugs are tested, so the supplements vary in quality and strength from pill to pill and bottle to bottle.

Just like supplements, foods can change the way your body responds to medications. One example is grapefruits and grapefruit juice. Many people aren’t aware that grapefruit juice can increase the drug levels of certain medications. An increase in the levels will also increase the side effects of the drug.

Things to Remember

1. Herbal supplements and foods can change the way your medications work.
2. Tell your caregiver what Herbal supplements you take and what foods you eat often.
3. Ask your Doctor or Pharmacist what Herbal supplements or foods will interact with your medications.
4. Always talk with your Doctor or Pharmacist FIRST before taking any Herbal supplements.

DISCLAIMER: The following charts are not all inclusive and do not contain every interaction of drugs with foods and herbs. It serves as a guide only. Consult with your Doctor, Pharmacist or a registered dietician if you have any questions.

Analgesics (Pain Relievers)

Celecoxib (Celebrex)
Ibuprofen (Advil, Motrin)

Food: Avoid alcohol. Avoid large amounts of orange juice and vitamin C.
Herbs:Avoid Black Cohosh, Dong Quai, Evening Primrose, Feverfew, Flaxseed Oil, and Ginko as it increases the risk of bleeding.

Codeine (Tylenol #2, 3, 4)
Morphine (MS Contin)
Oxycodone (Oxycontin/Percocet)

Foods:Avoid alcohol.
Herbs:Do not take with Kava or Valerian as it may make you feel drowsy.


Ciproflaxacin (cipro)
Levofloxacin (Levaquin)

Food: Take 2 Hrs before or 6 Hrs after antacids, dairy products amd multi-vitamins that contain calcium, iron, zinc, or magnesium. Avoid large amounts of caffeine.See Chart 3 below.


Foods:Avoid alcohol during and 3 days after taking this medication to avoid nausea and vomiting.


Foods:Citrus fruits/juices and carbonated beverages will decrease desired effect.


Foods:Take 2 Hrs before or 6 Hrs after antacids, dairy products amd multi-vitamins that contain calcium, iron, zinc, or magnesium.
Herbs:Dong Quai or St. John’s Wort increase the risk of sunburn.

Trimethoprim/Sulfamethoxazole (Bactrim, Septra)

Foods:May cause rash if taken with alcohol.
Herbs:Dong Quai or St. John’s Wort increase the risk of sunburn.

Anticoagulants (Blood Thinners)

Warfarin (Coumadin)

Food: Avoid alcohol. Avoid foods high in Vitamin K: beef liver, oils and green leafy vegetables (broccoli, brussel sprouts, cabbage, collards, spinach).
Herbs: Avoid Black Cohosh, Dong Quai, Evening Primrose, Feverfew, Flaxseed Oil and Ginko as they increase the risk of bleeding. Do not take St. John’s Wort as it may decrease the desired effect.

Cholesterol Lowering Agents

Atorvastatin (Lipitor)
Pravastatin (Pravachol)
Rosuvastatin (Crestor)
Simvastatin (Zocor)

Food: Avoid alcohol. Do not take with grapefruit juice.
Herbs: St. John’s Wort may decrease desired effect.

Diabetes Medications

Glipizide (Glucotrol, Glucotrol XL)
Glyburide (Glynase, Micronase)
Metformin (Glucophage)

Food: Avoid alcohol.
Herbs: Do not take with Ephedra as it may increase blood sugar and decrease desired effect.

Erectile Dysfunction

Sildenafil (Viagra)
Tadalafil (Cialis)
Vardenafil (Levitra)

Food: Do not take with grapefruit juice.
Herbs: Do not take with Yohimbe as it may increase side effects.

Gastrointestinal Agents (Stomach Meds)

Prochlorperazine (Compazine)

Food: Do not take with alcohol.
Herbs: Do not take with Dong Quai, Kava, St. John’s Wort or Valerian as they may make you drowsey.

Cimetidine (Tagamet)

Foods: Avoid alcohol. Take 1 hour before or 2 hours after antacids. Limit caffeine intake; see Chart 3.
Herbs: St John’s Wort may decrease desired effect.

Lansoprozole (Prevacid)
Omeprazole (Prilosec)
Pantoprazole (Protonix)
Rabeprazole (Aciphex)

Foods: Avoid alcohol as it may cause upset stomach.
Herbs: St. John’s Wort may decrease desired effect.

Heart and Blood Pressure Medications
*Note: The following herbs may cause an INCREASE in blood pressure and decrease desired effect of any blood pressure medications: Black Cohosh, Dong Quai, Ephedra, Hawthorn, Quassia, Vervain and Yohimbe.

Angiotensin Converting Enzyme (ACE) Inhibitors-
Captopril (Capoten)
Linisopril (Prinivil, Zestril)

Food: Avoid salt substitutes that contain potassium and potassium rich foods; see Chart 1.
Herbs: See *Note above

Beta Blockers-
Atenolol (Tenormin)
Metoprolol (Lopressor, Toprol ZL)
Propranolol (Inderal)

Foods: Avoid alcohol.
Herbs: See *Note above.

Calcium Channel Blockers-
Diltiazem (Cardizem, Tiazac)
Verapamil (Calan, Verelan)

Foods: Do not take with grapefruit juice. A low sodium diet may be recommended.
Herbs: See *Note above.

Digoxin (Lanoxin)

Foods: Avoid antacids. Limit caffeine intake; see Chart 3 below.
Herbs: Avoid Ma Huang and St. John’s Wort as they may decrease desired effect.

Isosorbide (isordil, Imdur)
Nitroglycerin Patch (Nitrol)

Foods: Avoid alcohol.
Herbs: See *Note above.

Diuretics (Water Pills)

Furosemide (Lasix)

Food: INCLUDE potassium rich foods in diet; see Chart 1 below.
Herbs: See *Note above under Heart and Blood Pressure Medications.

Hormone Replacement Therapy

Estrogen (Premarin, Premphase, Prempro)

Food: Avoid alcohol.
Herbs: St John’s Wort may decrease desired effect. Do not take Black Cohosh Dong Quai, Red Clover or Saw Palmetto because of the possible side effects.

Mood Disorders

Aripiprazole (Abilify)
Clozapine (Clozaril)
Olanzapine (Zyprexa)
Risperidone (Risperdal)

Food: Avoid alcohol. Do not take grapefruit juice. Limit caffeine intake; see Chart 3.
Herbs: Do not take with Kava, St. John’s Wor or Valerian as they may make you feel drowsy.

Alprazolam (Zanax)
Clonazepam (Klonopin)
Diazepam (Valium)
Lorazepam (Ativan)

Foods: Avoid alcohol. Do not take grapefruit juice. Limit caffeine intake; see Chart 3 below.
Herbs: Do not take with Kava, St. John’s Wor or Valerian as they may make you feel drowsy.

Lithium (Eskalith, Lithobid)

Food: Avoid alcohol. Limit caffeine intake; see Chart 3 below.
Herbs: Avoid Green Tea.

Monoamine Oxidase Inhibitors (MAOI’s)-
Phenelzine (Nardil)
Tranylcypromine (Parnate)

Foods: Avoid alcohol. Avoid tyramine-rich foods see Chart 2 below.
Herbs: Do not take with Ephedra, Kava, Ginko, St. John’s Wort or Yohimbe as they may increase effect and cause a serious increase in blood pressure.

Selective Seratonin Reuptake Inhibitors (SSRI’s)-
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil)

Food: Avoid alcohol.
Herbs: Do not take with Ephedra, Kava, Melatonin, Valerian or Yohimbe as they may make you drowsy. Do not take with St. John’s Wort as it may increase effect of drug and risk of side effects.

Tricyclic Antidepressants (TCA’s)-
Amitriptyline (Elavil)
Desipramine (Norpramin)
Nortriptyline (Pamelor)

Foods: Avoid alcohol. Do not take with grapefruit juice.
Herbs: Do not take with Kava, St. John’s Wort or Valerian as they may make you feel drowsy.

Oral Contraceptives (Birth Control)

Estradiol Cypionate
Ethinyl Estradiol

Food: Avoid smoking.
Herbs: Do not take with Chaste Tree Berry, Red Clover, Saw Palmetto or St. John’s Wort as they may decrease desired effect.


Alendronate (Fosomax)
Risendronate (Actonel)

Food: Take only with plain water. Do not take anything else within 30 minutes of taking these drugs as they may decrease desired effect.

Seizure Medications

Carbamazepine (Carbatrol, NOT Tegretol)
Divalproex (Depakote)
Oxcarbazepine (trileptal)
phenytoin (Dilantin)

Food: Avoid alcohol. Do not take with grapefruit juice.
Herbs: Evening Primrose increases risk for seizures. Do not take with Kava or Valerian as they may make you feel drowsy. St. John’s Wort may decrease desired effect.

Thyroid Medications

Levothyroxine (Levoxyl, Synthroid, Unithroid)
Thyroid (Armour Thyroid)

Food: Limit intake of Brussel Sprouts, cabbage, kale, greens, rutabaga, soybeans and turnips.
Herbs: Do not take with Lemon Balm.


Chlorpheniramine (Chlor-Trimeton)
Diphenhydramine (Benadryl)

Food: Do not take with alcohol.
Herbs: Do not take with Kava or Valerian as it may make you feel drowsy.

Cyclosporine (Neoral, Sandimmune)

Foods: Do not take with grapefruit juice.
Herbs: Do not take with Echinacea or St. John’s Wort as they may decrease desired effect.


Food: Avoid alcohol. Calcium supplements may be recommended to prevent Osteoporosis.Limit caffeine intake; see Chart 3 below.
Herbs: Avoid Echinacea or St. John’s Wort as they may decrease desired effect.

Theopylline (theo-Dur)

Foods: Avoid alcohol.Limit caffeine intake; see Chart 3 below.
Herbs: Do not take with Ephedra or Green Tea as it may increase effect of drug.


Chart # 1

High potassium rich foods include the following:

Apricots, Artichokes, Asparagus, Avacado, Banana, Broccoli, Brussel Sprouts, Carrots, Celery,
Chocolate, Dates, Dried Beans, Dried Fruit, Figs, Greens, Honeydew, Milk, Orange Juice, Potato,

Pumpkin, Prune Juice, Raisins, Rhubarb, Spinach, Squash, Tomato, V-8 Juice

Chart # 2

High tyramine-content foods include the following:
Aged Cheese*, Aged Meat,Anchovies, Avacados, Bananas, Beer, Broad Beans, Caffeine

Chicken Liver, Chocolate, Cola Drinks, Canned Figs, Mushrooms, Raisins, Sausages, Sour Cream
Soy Sauce, Wine (Chianti, Sherry), Yeast, Yogurt

*Camembert, Chedder, Gruyer, processed American and Stilton

Chart # 3

High caffeine-content foods include the following:
Chocolate (milk and dark, Coffee (brewed, cappuccino, expresso)
Caffeinated water (Java, Kank, Aqua Blast), Ice Cream (coffee, chocolate)
Soft Drinks (Mountain Dew, Coca Cola, Pepsi, Root Beer, Sunkist Orange Soda)
Teas (green Tea, Ginseng, Snapple Iced Tea, Lipton)

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